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Development and Validation of Risk Stratification for Heart Failure After Acute Coronary Syndrome Based on Dynamic
Jie Ma1,2, Ke Ma1,2, Jing Chen1,2
1Beijing Anzhen Hospital of Capital Medical University Beijing China.
Insights
Early assessment of heart failure (HF) risk after acute coronary syndrome (ACS) is crucial. S100A8/A9 levels on day 1 effectively predict HF risk, aiding in patient stratification and guiding treatment decisions.
Area of Science:
- Cardiology
- Biomarkers
- Acute Coronary Syndrome Research
Background:
- Early heart failure (HF) risk assessment in acute coronary syndrome (ACS) patients can decrease mortality.
- S100A8/A9, a marker released during myocardial ischemia and involved in reperfusion injury, is a key predictor of HF post-ACS.
- Developing a reliable HF risk stratification tool based on dynamic S100A8/A9 changes is essential for ACS patients post-reperfusion therapy.
Purpose of the Study:
- To construct and validate a reliable tool for heart failure (HF) risk stratification in patients with acute coronary syndrome (ACS) after reperfusion therapy.
- To evaluate the predictive value of dynamic changes in S100A8/A9 levels for HF development.
- To assess the impact of beta-blocker therapy on HF events in different risk groups.
Main Methods:
- Prospective study involving 3 independent cohorts of ACS patients undergoing reperfusion therapy.
- Serum S100A8/A9 levels were measured at various time points (admission, days 1-4) in the discovery cohort and on day 1 in validation cohorts.
- HF events (in-hospital and long-term) were tracked with median follow-up periods ranging from 1.8 to 4.2 years.
Main Results:
- S100A8/A9 levels measured on day 1 post-admission demonstrated superior predictive ability for HF compared to other time points.
- A risk stratification model using S100A8/A9 on day 1 identified high-risk patients (>7900 ng/mL) with significantly higher 1-year HF event rates (46-38%) versus low-risk patients (<2100 ng/mL) (2-5%).
- In patients without left ventricular dysfunction post-ACS, beta-blocker therapy reduced 1-year HF events in intermediate-to-high-risk groups but not in low-risk individuals.
Conclusions:
- Serum S100A8/A9 levels measured on day 1 post-ACS reliably classify patients according to their risk of developing heart failure.
- This biomarker serves as a robust tool for HF risk prediction and can guide therapeutic interventions.
- The findings support the use of S100A8/A9 as a dynamic marker for personalized risk assessment and management in ACS patients.
Background:
The early assessment of heart failure (HF) risk in patients with acute coronary syndrome (ACS) can help reduce mortality. S100A8/A9 is not only rapidly released after myocardial ischemia, but is also involved in reperfusion injury, which is an important predictor of HF after ACS. We attempted to construct a reliable HF risk stratification tool for evaluating patients with ACS after reperfusion therapy based on S100A8/A9 dynamic changes.
Methods And Results:
This prospective study included 3 independent cohorts of patients with ACS who received reperfusion therapy. The discovery cohort was divided into 2 subgroups: the longitudinal subgroup (n=264) with serum S100A8/A9 levels measured at admission and on days 1, 2, 3, and 4 postadmission, respectively, and the 2-point subgroup (n=798) with S100A8/A9 levels measured at admission and on day 1 postadmission, respectively. Validation cohorts 1 (n=1399) and 2 (n=1183) both had S100A8/A9 levels measured on day 1 postadmission. HF events included in-hospital HF events after the initial presentation and long-term HF events after discharge. The median follow-up for the discovery cohort, validation cohort 1, and validation cohort 2 was 4.2, 2.6, and 1.8 years, respectively. In the discovery cohort, S100A8/A9's predictive ability at day 1 surpassed other time points. Through the S100A8/A9-guided risk stratification, patients deemed high risk (>7900 ng/mL) exhibited a higher 1-year HF event rate (46% versus 2%, 38% versus 5%) than patients at low risk (<2100 ng/mL) in both validation cohorts. Among patients without left ventricular dysfunction after ACS, β-blocker therapy correlated with reduced 1-year HF events in intermediate-to- high-risk patients but not in low-risk patients.
Conclusions:
S100A8/A9 levels on day 1 accurately classified patients at varying risks of HF, serving as a robust tool for HF risk prediction and treatment guidance.
Registration:
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03752515.
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